Posted by robinibor on January 30, 2002, at 23:43:58
In reply to Re: my reservations about cbt » jane d, posted by sid on January 29, 2002, at 14:26:24
Just in case some of this is helpful, I went through a bunch of Dick's material and copied out 2 paragraphs on Psychotherapy and 3 on CBT that ARE NOT on our website.
Psychotherapy is the process of talking out one's problems to a trained professional. There are many ways of conducting psychotherapy, but all depend on an open, trusting relationship. For some patients, the opportunity to disclose to the therapist all the guilt and shame accompanying depression without being judged is enough to start recovery. For others, the therapist will need to provide guidance in such areas as assertiveness, communication skills, setting realistic goals, relaxation, and stress management, which are problems that commonly interfere with recovery from depression.
Psychotherapy can be provided by a psychiatrist (an MD specializing in mental disorders), a psychologist (Ph.D.), a clinical social worker (MSW), a psychiatric nurse, pastoral counselor, or substance abuse counselor. Note that anyone can hang out a shingle calling himself a "therapist" or "counselor." Ask directly about the individual's professional background and training. Ask if they are recognized as reimbursable by health insurance--if not, consider finding someone else. Finding someone you trust and can feel comfortable with is most important—people should feel encouraged to shop around. A patient definitely should ask about the therapist's background, training, and experience with depression. And if after a few sessions you have any doubts or don't feel you're getting anywhere, tell your therapist about it and get a consultation with someone else. Because medications can be so effective for depression now, their use should be strongly considered along with psychotherapy. Nowadays a good therapist should be associated with a psychiatrist who can prescribe needed medications.
Psychotherapy for depression need not take a long time. Two short-term approaches which have been reliably demonstrated to be effective with depression are cognitive therapy and interpersonal therapy. Cognitive therapy, based on the work of Aaron Beck, identifies a person's distorted thinking habits and recasts them in a more accurate light. For instance, "If my husband gets mad at me, that means he doesn't love me, and I can't live without his love" becomes "If he gets mad at me, that's unpleasant but expected he can be angry and still care about me." Interpersonal therapy, developed by Gerald Klerman and Myrna Weissman, focuses on communication skills: learning to interpret accurately what others are saying to you (instead of assuming you know), and learning to voice your feelings, desires, and needs effectively. Many experienced therapists will use techniques from cognitive and interpersonal therapies as needed by the individual.
Patients who request literature on depression from NIMH or other sources will often find cognitive or interpersonal therapy cited as the treatment of choice for depression. The reason why these approaches get this recognition is that they have been demonstrated, in experiments with all proper scientific controls, to be effective, at least as effective as medication. But the reason why they can be proven effective like this is because they have been elaborated to such a concrete level that one therapist's cognitive therapy is much like another therapist's cognitive therapy. This is not the case in most kinds of psychotherapy, where the personality of the therapist is such an important factor. This puts cognitive and behavioral therapy at a distinct advantage in the research, just because there is so little variability you are evaluating the effectiveness of a set of techniques, not an art. Experienced therapists sometimes denigrate these approaches as "cookbook" methods because they leave little room for creativity.
Cognitive therapy has become so accepted now as a standard treatment for depression that some are considering depression largely a symptom of dysfunctional thought processes. This runs the risk of encouraging the depressive's thinking that he needs more control, not less. If he continues depressed, he is likely to feel that he has done a poor job of applying cognitive methods, which just reinforces his sense of self-blame and inadequacy. Depressives need to get out of their heads and into their hearts and their bodies. The best therapists recognize that depression is a very complex condition and that changing faulty thought processes is just one of many possible ways of treating it, and that addressing these thought processes is going to have repercussions in other areas of the patient's life--how he processes feelings, how he communicates with those close to him, how he feels about himself.